Mycotic aneurysm of the superior mesenteric artery is an uncommon event usually preceded by a severe infection such as bacterial endocarditis. The authors report one such case successfully treated by resection without need for subsequent revascularization for bowel resection. Previous literature and case reports are reviewed.

A thirty-three year old white male presented with a single gunshot wound to the body of T10-11 with resultant paraplegia. Vascular examination was unre markable. In the work up of the paraplegia, the patient was found to have suprarenal aortic traumatic pseudoaneurysm, successfully repaired with tube graft replacement. This represents a rare presentation of an occult suprarenal penetrating aorta injury.

A case of salmonella infrarenal aortic aneurysm that ruptured and was treated with staged operative procedures and a highly effective antibiotic is reported and analyzed. An emergency situation with a ruptured abdominal aortic aneurysm required prompt surgical intervention with an aortobifemoral graft insertion. In the immediate postoperative period it was realized that a prosthetic graft was placed in the bed of a mycotic aneurysm. The patient had significant arteriosclerotic occlusive disease limiting the distal anastomotic site to the common femorals. Interoperatively the superficial femorals were noted to be occluded chronically. Consequently, revascularization via an extra-anatomical bypass after aortobifemoral graft removal was more complex. This was managed in a staged delayed fashion, while suppressing the infecting organism with Cefotaxime. The details of this complex situation are described within.

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